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NPI Code Detail

MEDICARE: MICHAEL BRANDON WATTERS

MEDICARE: MICHAEL BRANDON WATTERS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantA4572NC

General Provider Information

NPI Number : 1801183025
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL BRANDON WATTERS
Provider Business Mailing Address
First Line : 570 BEAVERDAM RD
Second Line :
City : ASHEVILLE
State : NC
Zip : 28804-1946
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 75 FISHER LOOP
Second Line :
City : MAGGIE VALLEY
State : NC
Zip : 28751-5531
Country : US
Telephone Number : 610-925-4114
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2011
Last Update Date : 07/08/2011

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